Berberine has 5 documented interactions in Magellan’s curated dataset, covering Immunosuppressants, Diabetes medications, ACE inhibitors and ARBs, Statins (cholesterol medications), Proton pump inhibitors (acid reducers). Each entry below gives the mechanism as the cited reference states it, the direction the risk runs, how serious that reference treats it, and what to actually do about it — which is, in every case, a conversation with the clinician or pharmacist who manages the prescription rather than a decision you make alone.
What it is. Berberine is a naturally occurring isoquinoline (benzylisoquinoline) alkaloid found in plants such as Coptis chinensis (Chinese goldthread), Berberis vulgaris (barberry), Hydrastis canadensis (goldenseal), Berberis aquifolium (Oregon grape) and Berberis aristata, with a long history of use in traditional Chinese and Ayurvedic medicine. Pharmacologically it activates AMP-activated protein kinase (AMPK), a central regulator of cellular energy balance, and modulates glucose and lipid metabolism, inhibits hepatic gluconeogenesis, and alters the gut microbiota.
Where it sits on the evidence. Magellan grades the supplement itself as Moderate evidence, with a typical studied dose of 500 mg, 2–3×/day. That grade is about whether it works, not about whether it is safe alongside your medication — the two questions are independent, and this page answers only the second.
Products this covers: Berberine HCl 500 mg (AMPK).
How the risks cluster. The entries split across 2 different mechanisms — drug levels; additive — and they are not managed the same way, so read each one rather than assuming a single rule covers all of them.
Safety and efficacy are separate questions, and this page only answers the first. For the second, the study Magellan’s coverage of Berberine rests on is:
“Across 37 RCTs (n=3,048) in type 2 diabetes, berberine lowered fasting glucose by about 0.82 mmol/L and HbA1c by about 0.63% without increasing hypoglycemia — though the underlying trials were mostly small and of variable quality.”
A strong result does not make a supplement safe alongside your prescription, and a documented interaction does not mean the supplement does not work. Magellan grades those two things separately, and neither grade moves for a commission.
Magellan’s Medication Safety Check runs entirely on your device — type the medicines you take and it flags every documented interaction in this dataset. Nothing you type is sent anywhere.
Open the Medication Safety Check →Berberine inhibits liver CYP450 enzymes (CYP3A4) that metabolize cyclosporine, which can raise cyclosporine blood levels and increase risk of toxicity; clinicians explicitly flag this combination as needing caution.
Medicines in this group include: Cyclosporine (Neoral, Sandimmune), Tacrolimus (Prograf, Astagraf), Sirolimus (Rapamune, Rapamycin), Mycophenolate (Cellcept, Myfortic), Azathioprine (Imuran).
Berberine independently lowers blood glucose through mechanisms that overlap with metformin's; combined with diabetes medications it can cause additive or excessive blood-sugar lowering, and should not be substituted for prescribed diabetes therapy without medical supervision.
Medicines in this group include: Metformin (Glucophage, Fortamet), Insulin (Humalog, Novolog), Glipizide (Glucotrol), Glyburide (Diabeta, Glynase), Glimepiride (Amaryl), Sitagliptin (Januvia), Empagliflozin (Jardiance), Dapagliflozin (Farxiga) and 5 more.
Berberine has its own blood-pressure- and heart-rate-lowering effects and is processed via liver enzyme pathways shared with drugs like losartan; combined use may compound blood-pressure lowering or alter drug levels.
Medicines in this group include: Lisinopril (Prinivil, Zestril), Enalapril (Vasotec), Ramipril (Altace), Captopril (Capoten), Benazepril (Lotensin), Losartan (Cozaar), Valsartan (Diovan), Olmesartan (Benicar) and 3 more.
Berberine and statins share CYP3A4 metabolism; pharmacology research shows berberine can alter statin blood levels and, combined, may increase cardiotoxicity risk via CYP3A4/hERG-channel effects. Evidence is largely mechanistic/preclinical rather than large human trials, so caution and monitoring are advised rather than an absolute contraindication.
Medicines in this group include: Atorvastatin (Lipitor), Simvastatin (Zocor), Rosuvastatin (Crestor), Lovastatin (Mevacor, Altoprev), Pravastatin (Pravachol), Pitavastatin (Livalo), Fluvastatin (Lescol).
Berberine may alter the metabolism of drugs processed through similar liver enzyme pathways, including omeprazole, though clinical significance appears limited.
Medicines in this group include: Omeprazole (Prilosec), Esomeprazole (Nexium), Lansoprazole (Prevacid), Pantoprazole (Protonix), Rabeprazole (Aciphex).
These are the warning signs that go with the medication classes on this page. They are general safety-netting, not a prediction that any supplement will cause them.
If something feels seriously wrong, do not wait for an appointment. Call 911 (US) or your local emergency number.
Severity describes the interaction as the cited reference frames it, not how a specific person will react. A “minor” entry in someone with kidney disease, on five other drugs, can matter more than a “major” one in someone on nothing else.
This is a curated set of interactions with citations — not an exhaustive pharmacology database. An interaction that is absent here has not been ruled out; it may simply not be documented in the references Magellan curates from. Supplements are also not batch-tested for identity or contamination the way prescription drugs are, so what is on the label is a claim rather than a guarantee. And most of these entries come from case reports and mechanistic work rather than randomized trials, which is exactly why the sensible response is a pharmacist review rather than either alarm or dismissal.
7 documented interactions across 7 supplements.
9 documented interactions across 9 supplements.
15 documented interactions across 14 supplements.
3 documented interactions · shares a drug class with Berberine.
3 documented interactions · shares a drug class with Berberine.
2 documented interactions · shares a drug class with Berberine.
2 documented interactions · shares a drug class with Berberine.
The mechanism and the research behind the compound itself.
A–Z of every supplement and drug class in this dataset, plus how to read an interaction.
What the research actually shows, graded independently of affiliate commissions.
Not without checking with the prescriber or pharmacist first. Magellan's dataset grades this as a major interaction: Berberine inhibits liver CYP450 enzymes (CYP3A4) that metabolize cyclosporine, which can raise cyclosporine blood levels and increase risk of toxicity; clinicians explicitly flag this combination as needing caution. (Source: Berberine: What It Is, Benefits & Side Effects.)
5 interactions are documented in Magellan's curated dataset: 2 major, 2 moderate, 1 minor. They cover Immunosuppressants, Diabetes medications, ACE inhibitors and ARBs, Statins (cholesterol medications), Proton pump inhibitors (acid reducers). Absence from this list is not proof of safety — it means no interaction is documented in the references we curate from.
Magellan lists the typical studied dose as: 500 mg, 2–3×/day. Dose matters for interactions — several of the entries on this page describe effects that only appear at supplemental rather than dietary intakes.